Damage to joint cartilage is likely to lead to long term joint problems. This is largely because cartilage does not have a direct supply of blood and thus cannot be quickly repaired naturally by the body. Joints are also particularly vulnerable to degeneration because it is common for the needs of their repair to outstrip the body's ability to produce new cartilage.
Cartilage is a watery substance, made up of 65 to 80% water plus collagen and proteoglycans which form the cartilage matrix, and special cells called chondrocytes. Collagen and proteoglycans are the substances which confer the amazing resilience and shock absorption qualities of cartilage and make it possible for the ends of the bones to slide effortlessly and smoothly across each other. Thus Glucosamine and Chondroitin are an essential part of the structure of cartilage.
Collagen, a vital part of cartilage, is a primary connective tissue, which exists in various forms and performs many different functions. Acting rather like an adhesive or glue-like substance throughout the body, it helps maintain structure and in cartilage it provides a framework to hold the proteoglycans in place as well as providing elasticity and shock-absorbency.
Proteoglycans, are huge, complex molecules composed of proteins and sugars. They interlink with the collagen fibers, forming a dense matrix or network inside the cartilage, making it resilient so that it can stretch when we move, and spring back into place. Proteoglycans also trap water from the tissues, acting like a sponge giving cartilage the flexibility needed to compensate for constant movement in the joint.
Chondrocytes are cells responsible for the repair and regeneration of cartilage tissues, both its removal when damaged, and its synthesis. Enzymes produced by the chondrocytes tear down damaged or old cartilage, just as proteoglycans synthesized by the chondrocytes renew cartilage. Both steps are necessary for joint health and a balance needs to be maintained.
Osteoarthritis usually involves joints which sustain a great deal of movement, such as the knees, elbows, thumbs and fingers. Rarely does osteoarthritis inflict the more static joints such as those which connect the spine to the pelvis. A large range of motion and the demands of constant use, especially bearing weight can damage the cartilage of the joints. Not just age, but sports and accidents can lead to similar damage. Repetitive motions and just plain everyday wear and tear contribute to loss of joint tissue. Whatever the cause, if stress and inflammation continue long enough, blood vessels will penetrate the cartilage and further weaken the joint tissue.
Cartilage is very tough and resilient, but it is slow in its repair and replacement, often even slower than bone. This has several implications, one of which is that, unlike many other tissues, relieving the symptoms of injury to cartilage may not be synonymous with repair. The use of aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) will relieve the pain of arthritis, but these do nothing to encourage joint repair. In fact, NSAIDs can actually accelerate the degenerative process while they mask the underlying problem by reducing the pain.
Age is a factor in cartilage health. The destructive process is accelerated by inflammation and injury, often accompanying aging. The process of cartilage synthesis is heavily dependent upon adequate nutrition and is also slowed with advancing age.
In a person with joint issues, cartilage is destroyed faster than it is synthesized. The key limiting step on the synthesis side is production of glucosaminoglycans (GAGs), for which Glucosamine is the basic building block.
Glucosamine, is a natural substance found in the body and made from the combination of a sugar (glucose) and an amine, derived from the amino acid, glutamine. Available throughout the body, but found largely in the cartilage, Glucosamine is an important part of the mucopolysaccharides which form the proteoglycans which provide structure to the bones, cartilage, skin, nails, hair and other body tissues. Glucosamine is essential for healthy cartilage, and to maintain healthy joints and pain-free mobility.
Numerous studies demonstrate benefits of Glucosamine. The National Institutes of Health - National Institute of Arthritis and Musculoskeletal and Skin Diseases — reports that Glucosamine and Chondroitin sulfate trials show probable usefulness for osteoarthritis. NIH references a systematic analysis of 37 clinical trials on Glucosamine and Chondroitin sulfate for treating osteoarthritis (OA) which has shown that these compounds may have some efficacy against the symptoms of this most common form of arthritis, in spite of problems with trial methodologies and possible biases.1
Glucosamine, however, does not act alone. Other nutrients must be available in adequate amounts if it is to be used efficiently in the synthesis of cartilage.
Chondroitin sulfate is a natural substance found in the human body. Chondroitin prevents other body enzymes from degrading the building blocks of joint cartilage. Formed from a long chain of sugar molecules, Chondroitin acts like a 'liquid magnet', helping to attract fluid into the proteoglycan molecules. This is important for two reasons:
1. The fluid acts as spongy shock absorber, and also sweeps nutrients into the cartilage.
2. Joint cartilage has no blood supply which means its nourishment and lubrication comes from the liquid which enters and leaves the cartilage as pressure is applied to the joint.
The best way to determine if a substance improves the condition of joints is to actually look at the joint tissue under a microscope after treatment. This is exactly the kind of study Dr. Louis Lippiello, M.D. presented at the 63rd annual meeting of the American College of Rheumatology in Boston in 1999. The study was published in 2000 in the Clinical Orthopedics journal.2 Other studies report the clinical effects of the use of Glucosamine and Chondroitin in human patients.1
Since most people would not take kindly to having biopsies of cartilage removed from their already delicate joints, the researchers used rabbits. Thirty-six rabbits were split into four groups: one group was fed Glucosamine, one group Chondroitin, and one group Glucosamine and Chondroitin in addition to their regular rabbit feed. The fourth group was essentially getting a placebo (just the normal food). The rabbits were not told which were getting supplementation. All the rabbits underwent a standard surgical procedure to accelerate the progression of osteoarthritis in the rabbits’ back legs.
After 16 weeks, biopsies of the cartilage were examined and graded using a standard system. As expected, the Glucosamine and Chondroitin groups had less severe cartilage damage than the control groups with the following grades:
The major news comes from the combination group. Rabbits fed both Glucosamine and Chondroitin had, by far, the least signs of cartilage damage of any of the groups. This value, despite the small number of rabbits per group, was statistically significant.
In addition to the histologic (microscopic) grading of the cartilage, Dr. Lippiello and his colleagues also measured how well the supplements alone and in combination could stimulate production of cartilage components (called Glycosaminoglycans or GAGs).
Compared to control, Glucosamine increased GAG production by 32%, Chondroitin by 32%, but the combination of Glucosamine + Chondroitin increased cartilage production by 97%! The combination of Glucosamine + Chondroitin had a significant synergistic effect.2
MSM (Methyl Sulfonyl Methane) is a biological form of sulfur that has recently attracted a great deal of attention. In particular, MSM has generated broad anecdotal support for its benefits in cases of allergies, and joint health.
In the case of joint aging or joint and ligament injuries, MSM may work through several different mechanisms. For instance, it was discovered in the 1930's that arthritis can cause below normal levels of cystine (a metabolite of cysteine) in the fingernails. This can lead to brittle or soft nails and can be an indication of either inadequate sulfur in the diet or a poor ability to manipulate dietary sulfur to match the body's needs. Interestingly, when sulfur was given to 100 arthritis patients intravenously in one trial, many found that the pain and other symptoms of their arthritis disappeared and that their fingernails returned to normal in the nail test for cystine.
Sulfur is required for the repair and maintenance of joint tissues and the construction of connective tissues more generally. Sulfur is especially important for the body's production of Chondroitin sulfate, which acts to maintain the proper water levels, and therefore the cushioning properties of cartilage in joint tissue.
Supplementing with MSM ensures that the body has adequate amounts of sulfur. Recently, a small preliminary double-blind placebo-controlled study at UCLA showed that supplementation with MSM improved joint pain in 80% of the participants tested.
Several studies have shown that most users need 1200 mg to 1500 mg of Glucosamine and 900 mg to 1200 mg of Chondroitin daily for a period of three months to a year. This is because cartilage rebuilding is a slow process! A number of patients continue the supplementation at 1/2 of this dosage for prolonged benefit maintaining cartilage health.
Rejuvenation Science Advanced Cartilage Support II™ may be used together with Rejuvenation Science CM Joint Optimizer™ or by itself. Recommended initial dosage for Advanced Cartilage Support is 3 capsules daily with meals, providing 1,100 mg Glucosamine, 1,200 mg Chondroitin, and 300 mg MSM per day.
Because Calcium, Zinc, Manganese, Copper, Selenium, and Magnesium together with Vitamin C, Vitamin E and the B complex vitamins are important for bone health, make sure these are included in your diet, either from foods or supplements. Maximum Vitality™ and Skeletal Calcium™ are rich sources of these vitamins and minerals.
Engage in mild to moderate exercise on a regular basis to help maintain joint flexibility and bone strength.
Glucosamine taken alone or in combination with Chondroitin does not interfere with NSAIDs, aspirin, or any other anti-inflammatory or analgesic medication. Indeed, there is some evidence that taking this supplement may allow people to reduce their use of these strong drugs. Adjustment of medications prescribed by your doctor should be done under his supervision.
Both Glucosamine and Chondroitin have been used in Europe for many years, with few reported side effects. Glucosamine is derived from shellfish, and Chondroitin is provided in sea cucumber. Before taking any form of Glucosamine supplements, patients who are allergic to shellfish should check with their doctor. Glucosamine is essentially non-toxic even in doses many times greater than those needed for relief.
Unlike the potent nonsteroidal anti-inflammatory drugs (NSAIDs) usually prescribed for arthritis, Glucosamine, Chondroitin, and MSM do not produce serious side effects. In infrequent cases, people experience mild symptoms such as diarrhea, heartburn, indigestion, and nausea. Take the supplements with food if it upsets your stomach when taken alone (or if you have an ulcer).
1. McAlindon TM, LaValley MP, Gulin JP, Felson DM. Glucosamine and Chondroitin Sulfate for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis. JAMA. 2000;283:1469-1475.
2. Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop. 2000 Dec;(381):229-40.
Theodosakis, Jason, et. al. The Arthritis Cure. St. Martin's Press, New York, 1997.
NIAMS-Funded Analysis of Glucosamine/Chondroitin Sulfate Trials Show Probable Usefulness for Osteoarthritis. NATIONAL INSTITUTES OF HEALTH. Monday, March 20, 2000. http://www.niams.nih.gov/ne/press/2000/03_20.htm